Contributed by: Dr Grace Tan
General Surgeon and Surgical Oncologist
HIPEC stands for Hyperthermic intraperitoneal chemotherapy. It is a method of delivering chemotherapy that is often combined with surgery to treat peritoneal cancer. This combined modality of treatment is often termed Cytoreductive Surgery (CRS) and HIPEC.
Peritoneal cancer can arise from the peritoneal itself, but often develops as part of advanced, stage 4 cancer of the digestive tract (stomach, colon and rectum) and ovary. It has increasingly been recognised as an effective treatment option for patients with recurrent disease to the peritoneum (1,2).
CRS was first described by Spratt et al in 1980 (3) and popularised by Sugarbaker in the 1990s (4). It aims to remove all macroscopic peritoneal disease by resection of involved organs, followed by the removal of sections of involved peritoneum. HIPEC targets the microscopic diseases, and is delivered after the CRS is completed. The HIPEC is usually administered for 60-90 minutes. There are 3 main benefits of HIPEC –
1. When delivered into the peritoneum, a higher dose of chemotherapy can be given, with less side effects.
2. The chemotherapy in HIPEC is heated up to 40-42 degrees Celsius. At this higher temperature, the chemotherapy drug penetration is improved and provides a synergistic effect with the intraperitoneal chemotherapy.
3. When delivered into the peritoneum, there is direct contact between the tumour and the chemotherapy, making it more effective than intravenous or oral chemotherapy.
Ref:
1. Elias D et al. Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol 2010;28:63-8
2. Bakrin N et al. Peritoneal carcinomatosis treated with cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for advanced ovarian carcinoma: A French multicentre retrospective cohort study of 566 patients. EJSO 2013; 39: 1435–1443.
3. Spratt JS et al. Clinical delivery system for intraperitoneal hyperthermic chemotherapy. Cancer Res. 1980;40:256-60.
4. Sugarbaker PH.Peritonectomy procedures. Ann Surg. 1995;221:29-42.
